runners knee/workout question

[galya]

there is a girl that I have been working out with for about 3-4 months. She's been having knee problems for over a year (used to run a lot on a treadmill and outside, something like 6-10 miles every day for the last 10 years). She couldn't get diagnozed properly until three days ago (runner's knee,chondromalacia ). Before that I was warned by her doctor to stay away from any heavy leg work that outs stress on the knee, so for a few months we have only been doing adductions and abdustions, some ballet isometric exercises and isometric work on the floor. We do partial leg extensions on the machine, or full ones with light ankle weights. We really need to strengthen the quads though.
I would appreciate any feedback from anyone who has experience designing a program for such an injury.
thank you all in advance

[RedLefty]

Here's a webpage with a pretty good summary of what she's experiencing and the general tips for treatment and future prevention:

http://www.orthoseek.com/articles/chondromp.html

I've had two patella dislocations due to a similar problem, and I'd tell her to be careful with the statement "we need to strenghten the quads". It's likely that her inner quads could use some strengthening, but the outer quads may already be very strong, which could be causing some of the pain. Combine that with the unique hip/knee angle of females, and this is a pretty common result.

Specifically, she may want to strengthen the vastus medialis obliquus (VMO) and hamstrings, while not further tightening the iliotibial band.

[galya]

thanks, that is exactly what her case it: stronger quads on the outside. We are working on the inner, sounds good to add hamstring work, we've been doing very light curls so far. Shouldn't I be afraid of her hamstrings getting tight/too strong in relation to her quads.
Won't that make it worse?

Good link too
What do you think about adding aquatic exercises? I just looked at:
http://www.coacheseducation.com/water/pt_3/

[RedLefty]

It is extremely rare to see anyone with hamstrings too strong in relation to quads -- almost everyone is the opposite. She likely does not have to be afraid of over-developed hamstrings, especially if her past training centered on running.

For hamstring training, I would recommend some stiff-legged deadlifts or even good mornings, with light weights in the beginning so she can get used to the load. These do not require significant flexion of the knee joint like leg curls.

One other thought is for her to explore some myofascial release in the quads and iliotibial band, either from a specialist or with a foam roll she can use herself. It will likely be painful at first, especially on the IT band, but could prove useful if those areas are still very tight.

I don't see anything wrong with the aquatic exercises, but also I don't think there's anything particularly great about them. The above items I mentioned will probably keep her busy enough. [img]smile.gif[/img]

[galya]

Aquatic exrcises are fun and will keep her interested, she swims once a week and can do some exercise before that.
Oddly, stiff legged dl have been a part of her training in the last few months, and she has perefect form (most flexible females do)-it's one of the few exercises she has been able to do without me being concerned about the knee. She does not have any complains about tension in the IT band, just the patella after repeated movements like walking/running/stair climbing, but I'll throw the idea her way.
10q